Monday, July 13, 2009

Stupid Attending

I think that I have bashed the residents enough over the course of this blog. Since it is July I will be nice and lay off. They don't know any better...yet. The attendings however need a bit of abuse. If you are going to be an ED attending in a Level 1 urban department then you'd better know your shit.

The attending from last night graduated from our program about 6 years ago. He was a shitty, stupid resident and has been no better as a moonlighting attending. I don't feel like a Level 1 ED should be your part time job.

So my major malfunction with this guy is twofold. 1) He is slow as molasses in February. Patients that could be seen and dispo'd in an hour or less were taking over 2 hours to even be seen. That seriously slows shit down. 2) Let me tell a story.....

60 year old dude with wicked ascites. He looked about 10 months pregnant and was complaining of... guess what?!?!? SOB and abdominal pain. (Big freakin surprise) The nurse, who is a pain in my testicle, alowed him to lay flat... and what pray tell happens when you lay a 9 mo pregnant person flat? It compresses the aorta and shits out their BP. So I think this is what happened. We walk in the room and dude man is guppy breathing, has a pressure in the shitter and is completely unresponsive. Did I mention he looked pregnant? We estimated his weight at 120kg. When we went to RSI him the attending didn't know the dose of rocuronium (instead of Sux due to renal status). I blurted out 1mg/kg which was our protocol when I was flying. The doc disagreed. He wanted to dose at .3mg/kg. (I think he got the roc dose confused with the etomidate dose). After my insistence he at least went up to 50mg of roc which was less than half of the appropriate dose. UGH!!!! It is so frustrating trying to explain this to people who aren't going to listen.

So once we got this guy tubed I threw down an NG tube and got some fluids going. The doc attempted to place a femoral line. He missed (we thought) and then tried to convert to an a-line. When I got the a-line set up we saw a very distinct waveform..... a CVP waveform. He went through the vein and artery and shredded both! FUCK ME I don't want my name on this chart.

The patient's nurse (not me) witnessed the beginning of this pseudo-code... and then disappeared. When we looked he was in the nurses station documenting... he had nothing to do with his patient. At least the son of a bitch said thank you before I left this morning!


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